June 21, 2018
Dive
Brief:
- The
Centers for Medicare & Medicaid Services asked stakeholders Wednesday
for input on how to change the Stark Law to allow for
better care coordination and new alternative payment models or other novel
financial arrangements.
- The
American Hospital Association has been vocal in pushing for changes to the
physician self-referral law, calling it outdated. AHA argues the law
presents “nearly impenetrable roadblocks in the move toward value-based
care.”
- The agency specifically is
requesting input on what new exemptions to the Stark Law are needed to
protect accountable care organization models, bundled payment models and
other payment models, including how to allow coordination care outside of
an alternative payment model. It also asks for help examining definitions
for terminology such as risk-sharing, enrollee, gain-sharing and other
terms.
Dive
Insight:
The
Stark Law, enacted in 1989, aims to cut down on financial incentives impacting
physician care decisions. It prohibits certain Medicare-payable referrals to
entities they have a financial or familial relationship with, and stops such
entities from filing Medicare claims for referred services, unless exempted
under certain instances.
CMS
says that it is issuing the RFI in response to comments it has received that
raised concern that the Stark Law is impeding participation in healthcare
delivery and payment reform efforts.
“We
are particularly interested in your thoughts on issues that include, but are
not limited to, the structure of arrangements between parties that participate
in alternative payment models or other novel financial arrangements, the need
for revisions or additions to exceptions to the physician self-referral law,
and terminology related to alternative payment models and the physician
self-referral law,” the CMS notice states.
In
a statement submitted by AHA to the
House Subcommittee on Health of the Committee on Ways and Means, the
group urged Congress to step in to change Stark Law to allow hospitals and
physicians to more closely work together.
“Congress
should create a clear and comprehensive safe harbor under the anti-kickback law
for arrangements designed to foster collaboration in the delivery of health
care and incentivize and reward efficiencies and improvement in care,” AHA
said. “In addition, the Stark Law should be reformed to focus exclusively
on ownership arrangements. Compensation arrangements should be subject to
oversight solely under the anti-kickback law.”
CMS
Administrator Seema Verma appears to be sympathetic. In a Wednesday blog post,
she said the Stark Law may be prohibiting value-based arrangements that HHS has
made a priority to shift towards. Previously, Verma said that CMS was going to
put together an inter-agency group to examine potential changes to the law.
“I
think that Stark was developed a long time ago, and this gets to where we are
going modernizing the program,” Verma told AHA President and CEO
Rick Pollack during a webcast in January. “The payment systems and
how we are operating is different, and we need to bring along some of those
regulations and figure out what we can do. And I’m not sure that this is not
going to require some congressional intervention as well.”
CMS
is asking for comments to be submitted on the RFI by August 24.
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